Abstract
Introduction
NICE CG124 recommends that Hip Fracture Programmes should have responsibility for the whole pathway of patients’ recovery. Contacting patients at 120-days provides an ideal opportunity to examine how many of them are still on treatment and to offer support to those who are having problems. National Hip Fracture Database (NHFD) 120-day follow-up was introduced in patient’s electronic patient record (EPR) in December 2023.
Methods
All local hospital’s NHFD hip fracture patients (173) who have completed 120-day telephone clinic follow-up in year 2024 were included for data collection. Data collection is recorded in secured spreadsheet in Trust’s personal OneDrive through auditor's login. There was also a comparison of Trust’s automated data capturing from EPR and manual data collection.
Results
Comparing admission to discharge outcomes, mobility with use aids was almost the same after hip fracture from 118 (68%) to 123 (62%) collectively. Rehabilitation units still play a crucial role in helping hip fracture patients to physically progress, 39% of patients were transferred to it. There was 11% increased use of care homes (residential and nursing) on discharge. Regarding bone protections, there was increased utilisation of zoledronic (5% to 67%) and denosumab (1% to 6%). The factors that hinder utilisation of bone protections were severe frailty, advanced dementia, and very poor renal functions.
Conclusion
120-day follow-up is an effective process monitor progress of patients regarding hip fracture outcomes, and to filter patient who are suitable for the next infusion dose in day treatment units. However, there are challenges that were identified from the process itself, audit, and patient factors. This has also highlighted the need for collaboration to relevant departments such as IT for about data-capturing error, orthopaedics NHFD auditor missing or incomplete local forms for national database submission, and senior clinicians regarding ACP’s sponsorhip for DEXA scans.
Comments
Insightful analysis demonstrating the impact..
It’s great to see how the 120-day follow-up highlights the importance of ongoing patient monitoring after hip fracture, both in tracking recovery and ensuring patients receive appropriate bone protection treatments and further support required.
Thank you!
It has come a long way now since we looked at bone health of hip fracture patients and is still continuously evolving. Reflecting on this role and process, it is complicated and the local and national guidelines are there. But the local resource is the question, and we have to take every hip fracture patient individually - their clinical condition and social circumstances. On this regard, this will help us in clinical decision-making regarding their bone health.